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A bstract Variceal hemorrhage is a serious consequence of patients having chronic liver disease (CLD). Various scores exist that predict the outcome for non-variceal bleed. However, only a few scores evaluate patients with variceal bleed. We, in our study, evaluated 48 cirrhotics who presented with variceal gastrointestinal (GI) bleed over a period of 3 months. Majority of these were males and the most common etiology was hepatitis C infection. The main presenting complaints were hematemesis seen in 39.6% followed by hematemesis and melena in 31.25%. Most bleeding episodes were secured via banding in 62.5% followed by injection of histoacryl in 12.5%. Finally, Child–Turcotte–Pugh (CTP), model for end-stage liver disease (MELD), albumin-to-bilirubin (ALBI), and the ABC score were applied and none correlated with the presence of esophageal varices. However, the ALBI score did correlate with the presence of tachycardia in our study, a pertinent sign of upper GI bleed. How to cite this article Majid Z, Khan SA, Akbar N, et al . The Use of Albumin-to-bilirubin Score in Predicting Variceal Bleed: A Pilot Study from Pakistan. Euroasian J Hepato-Gastroenterol 2022;12(2):77–80.

Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative colitis patients. Both diseases commonly involve the colon. It has been shown that treating these patients with anti-tumor necrosis factor (anti-TNF) therapy leads to remission of both conditions. We hereby present the case of a 7-year-old boy who was initially managed as a case ulcerative colitis after undergoing extensive workup and later on tested positive for HIV infection and was managed via mesalamine and highly active antiretroviral therapy (HAART). Mesalamine therapy along with HAART can be used to treat ulcerative colitis patients infected with HIV infection in resource limited countries.

Background: Endoscopic ultrasound (EUS) is gaining attraction as an alternative method of obtaining biopsies. It offers a more targeted approach for focal lesions in liver especially for those areas which are accessible via EUS-guided method. Materials and Methods: A total of 8 patients underwent EUS-guided liver lesions biopsies (LLB). EUS Guided LLB was performed using the 22G FNA needle, 2 passes were done with slow pull technique over one minute with 10–15 strokes done in each pass to obtained core samples. The average duration of the procedures ranged from 15–30 minutes. Results: Out of 8 patients, majority were males. Most of these patients had presented with nonspecific signs and symptoms including weight loss, abdominal pain, jaundice etc. All of the 8 patients had an atypical liver lesions on initial radiological evaluation with inconclusive tumour markers and atypical CT radiological findings. Screening for Hepatitis B and C virus were negative in all of them. EUS guided biopsy performed in them revealed the following diagnosis: well differentiated adenocarcinoma, sarcomatoid carcinoma, neuroendocrine tumour, smooth muscle tumour, metastatic adenocarcinoma, lymphoproliferative disorder and malignant melanoma. Conclusions: EUS-guided LLB is an alternative new technique for biopsy of liver lesions with suspected atypical malignancies.

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